Eating Disorders in Men

The stereotypical person with an eating disorder is young, female and hyper-focused on weight gain. But eating disorders can affect all ages and genders. In fact, the National Eating Disorders Association reports about 1 in 3 people struggling with an eating disorder is male. Moreover, behaviors such as binge eating, purging, laxative abuse and fasting for weight loss are nearly as common among men as they are among women.

In fact, the prevalence of eating disorders in men is on the rise. According to a recent study in the American Journal of Men’s Health, an estimated 10 million boys and men in the United States will experience an eating disorder in their lifetime. But men are much less likely to seek treatment for this problem, due mainly to cultural bias.

Guys encounter a two-barreled stigma in addressing eating problems. One is that the issue is wrongly characterized as feminine. The other involves men’s general hesitancy to seek psychological help for fear it will be interpreted as a sign of weakness. Thus, due to the stigma and feelings of shame, men may deny their symptoms and hesitate to seek treatment.

What are eating disorders?

The American Psychiatric Association defines eating disorders as behavioral conditions characterized by severe and persistent disturbance in eating practices and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social function.

The main types are:

Anorexia nervosa – an eating disorder characterized by a distorted body image, causing people to obsess about weight and what they eat
Bulimia nervosa – a potentially life-threating disorder marked by binging, followed by methods to avoid weight gain, including vomiting (purging) or excessive exercising or fasting
Binge eating disorder - frequently consuming unusually large amounts of food in one sitting and feeling that eating behavior is out of control. Unlike people with other eating disorders, they do not purge.
Pica - craving and chewing substances that have no nutritional value, such as ice, clay, soil or paper
Rumination syndrome – a rare and newly recognized condition where a person spits up food from the stomach, rechews it and either swallows it again or spits it out. Because the food hasn't yet been digested, it reportedly tastes normal and isn't acidic, as is vomit.
Avoidant/restrictive food intake disorder – previously referred to as selective eating disorder, this condition is like anorexia in that both disorders involve limitations in the amount and/or types of food consumed. Unlike anorexia, food intake disorder does not involve any distress about body shape or size, or fears of fatness. While many children go through phases of picky or selective eating, a person with this disorder does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function.
Muscle dysmorphia -- a subtype of body dysmorphic disorder, this is an emerging condition that primarily affects male bodybuilders. These men obsess about being adequately muscular. Compulsions include spending many hours in the gym and squandering excessive amounts of money on supplements, following abnormal eating patterns or using steroids.

What do eating disorders in men look like?

More often, lots of guys are trying to get muscular and bulk up. So, the typical weight loss behaviors one might associate with this disorder do not apply here. In one study, masculine body ideals influence men’s behavior toward diet and exercise in distinctly different ways. Another recent study found that nearly a third of adolescent boys in the United States report they want to gain weight. Nearly a quarter of young men also report taking supplements, steroids or eating more to bulk up.

The pursuit of extreme weight loss can also be a problem for men in particular in certain high-risk groups.

Being able to identify an eating disorder can be difficult as one can’t always tell if someone is struggling with an eating disorder. As identified in this article, apparent signs of eating disorders are unique in that they have both mental and physical health consequences.

Identifying eating disorders among men as a mental health issue is crucial to advancing understanding around them, as has been the case with anxiety and depression in recent years.

Who is at high risk of developing an eating disorder?

Athletes, people of Color and LGBTQ people maybe at elevated risk of an eating disorders and their associated behaviors.

Body dysmorphia, an obsessive focus on perceived defects in one’s body, impacts women and men at equal rates, according to the Anxiety & Depression Association of America.

This is seen in transgender people, who may experience body dysmorphia in connection with gender dysphoria, the term for distress over discrepancies between one’s body and gender identity.

Why are body concerns among men on the rise?

Images of immensely muscular men are everywhere, circulating on apps like Instagram and taking on outsized proportions in the Marvel Cinematic Universe and on billboards and magazines. These dangerous messages of striving for the extreme muscular physique are reflected in our pop culture. This includes social media algorithms and Hollywood norms that continue to propagate body ideals that can be dangerously unattainable.

Broader cultural conceptions of how men are supposed to act also play a role in how men relate to struggle. For example, there is a view of the “tough guy” and the belief that a man has to keep a stiff upper lip at all times, is one of the main causes of stigma that men can’t have eating disorders.

One of the reasons men may be less likely to seek treatment due to having a sense of shame and stigma or recognize their obsession with diet and fitness as a problem. Addressing eating disorders in their early stages increases the likelihood of achieving full physical and emotional recovery, according to NEDA.

Treatment

Eating disorders are mental health conditions that usually require treatment. If left untreated, they can cause serious damage to the body and could even lead to death.

Statistics provided by the National Association of Anorexia Nervosa and Associated Disorders indicate eating disorders are among the deadliest mental illnesses, second only to opioid overdose. Combating the condition is especially challenging for men, who are often diagnosed later since many people assume men don’t suffer from eating disorders. The longer an eating disorder isn’t treated, the more likely stronger treatment will be needed.

Eating disorder treatment depends on the particular disorder and symptoms. It typically includes a combination of psychological therapy (psychotherapy), nutrition education, medical monitoring and sometimes medications. Treatment also involves addressing other health issues caused by an eating disorder, including low levels of testosterone and vitamin D, cardiovascular problems, and a high risk of osteopenia and osteoporosis.

According to the National Institute of Mental Health, typical treatment goals include:

Restoring adequate nutrition
Bringing weight to a healthy level
Reducing excessive exercise
Stopping binge-purge and binge-eating behaviors

People who receive treatment for eating disorders often recover and go on to lead healthy lives. It’s helpful to detect a problem early and start treatment right away. Health care providers can refer patients to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating eating disorders.

What can you do if you think you may have an eating disorder and need help?